Now there is only the covid-19 ICU. It takes up the entire floor, and soon it will overflow. I work there, as a resident physician training in critical care. And it is a chilling place.
A normal ICU is bustling, full of visits from patients’ families and friends. While the machines, tubes and hospital gowns can deprive patients of their individuality, visitors infuse character and life into the rooms. We get to know our patients through their families. I ask to see pictures of my patients from a time before they became ill.
Our covid ICU is desolate. Families aren’t allowed into the hospital, except in rare cases when a relative is given permission, out of compassion, to say goodbye to someone who’s about to die. Aside from the photographs of patients that are associated with their medical records, I don’t know what any of them looked like before they developed this life-threatening illness.
In a normal ICU, I spend time at my patients’ bedsides. I once cared for a woman who was intubated but awake. Her friend played her music from her phone. I painted her fingernails. I sat with her and hugged her. We communicated with our eyes. I could tell the difference between when she just needed to cry and when she needed medical answers to what was going on with her. When she died, I sobbed because I had lost someone I had grown to love.
But covid-19 puts so much distance between me and my patients. I enter their rooms only when it’s absolutely necessary, such as to place a feeding tube or adjust a ventilator. Personal protective equipment (PPE) is a precious resource right now, and each use of masks and gloves must be taken seriously. My patients’ lungs are so sick that we need the ventilators to do all the work of breathing for them. That means we have to give them two, sometimes three powerful sedatives. So even if I did spend more time with them, they’d barely be conscious.
A normal ICU is busy but manageable. Patients on ventilators get better and regain the ability to breathe on their own. When they move to another floor, a space frees up. A new patient who had been intubated in the emergency department takes that bed.
But the covid ICU only grows. Each day, new patients with the coronavirus require intubation and life support; they come to our department. And the patients already here aren’t getting better at the same rate as new patients get sick. Covid-19 is both a fast and a slow disease: It has overwhelmed our city at a frightening clip, and yet, once patients are on life support, we must wait days, even weeks, to see if they will recover. Our normal medical ICU has between 12 and 17 patients. The covid ICU has more than 50.
In a normal ICU, I am not afraid of catching infections from my patients. I’ve drawn blood from patients with poorly controlled HIV. I’ve breathed the same air — filtered through an N95 mask — as patients with active tuberculosis. I’ve trusted existing protocols to keep me safe. And I knew that in the unlikely event that I did contract a disease like HIV or tuberculosis from a patient, I would quickly receive effective treatment.
Now in the covid ICU, I fear that I will get sick and die. We have adequate PPE for the time being, but I’m not sure how long it will last or if it will really prevent all spread of the virus. Even though I’m in my 30s and healthy, I am by no means protected from this disease. I see my gray-haired colleagues, and I worry even more for them. I see how rapidly covid can take over someone’s body, and I can’t help but worry for my parents not too far away, in Upstate New York. I counsel them over FaceTime to stay home, wash their hands, keep distance from everyone else. I share some details of what I see at work with them to convey the seriousness of this pandemic. But I also hold back, wanting to shield them from the horror.
A normal ICU is a hard place to work: We witness death. We deliver the worst news possible. We see families grieve. I am someone who feels things intensely. Even when we’re not in the midst of a pandemic, I rarely make it through a week in the ICU without crying.
In our covid ICU, where nothing feels normal, my emotions aren’t normal either. I’m not crying over my patients like I usually do. The sheer number of them is overwhelming. Their illnesses are all, essentially, the same. Their families aren’t there to vouch for their individuality. So my mind has started treating patients as “cases” rather than human beings. Perhaps a hidden psychological mechanism is at play, protecting me from the profound tragedy of it all. Or at least putting it off until later.
What makes me cry now are reminders of normal life and normal medicine, from a time before the coronavirus. I cry on my walk to work as my ear buds play songs that conjure recollections of a pre-covid world. I cry when I see the trees blossoming across from the hospital, their pink flowers a sign of a spring spent indoors, isolating and intubating.
Last week on our ICU rounds, the attending critical-care physician took a few minutes to teach me some medicine that had nothing to do with covid. I got lost in curiosity and learning. I was happy. For a moment, the pandemic felt far away. I remembered what normal felt like, and I started to cry.